=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457703233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILLES MARTIAL TCHUENTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2016
-----------------------------------------------------
Last Update Date | 07/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6209 ERLAND WAY
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-713-7750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6209 ERLAND WAY
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-713-7750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HHA
-----------------------------------------------------
Name | GILLES MARTIAL TCHUENTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-713-7750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HH12194
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------